Taking one’s medicine seems like such a simple thing. But, for many, it often isn’t that simple.
For the last 10 years or so, I have had the luxury of not taking any regular medicine – just the occasional ibuprofen or allergy medication as needed. More recently, I’ve started taking medicines that, while they are supposed to help me, often are accompanied by side effects. Coincidentally, I have been working on a research paper on medication adherence, so I’ve been watching my own behavior closely.
I have the “remembering” part of the adherence task down pat: I have a system in the morning over breakfast and in the evening before bed where I’ve tied taking pills to other, well-established personal habits, like brushing my teeth.
I also have carefully read the information about the medications and what they are for and understand the potential side effects. And I’m blessed to have minimal cost sharing for these drugs.
But, I still feel deeply conflicted about having to take medicine at all, especially now that I have no symptoms of illness. It has made me have a much better appreciation for all the “non-adherent” people out there with hypertension or high cholesterol.
Some of my frustrations about medication adherence were echoed in findings from our recent study, Improving medication adherence: Tailored approaches may boost potential for success, which leveraged the Deloitte Center for Health Solutions 2015 Survey of US Health Care Consumers. We found that adherence is related to consumers’ attitudes about the health care system, wellness, and engagement with digital tools. Specifically, our study reveals that people who are more positive about incentives are more likely to report greater adherence. Lower rates of reported adherence are associated with individuals’ demographic and socioeconomic characteristics, which is consistent with industry literature.
We also found that more than half of consumers (54 percent) are interested in using digital tools and mobile technology that provide alerts and reminders to take their medication. Although current use of these tools is only 13 percent among the surveyed individuals who had a prescription in 2015, many people who used the tools say they are very or somewhat interested in receiving this type of information. Among the larger group of people who had not tried these tools, 42 percent of the respondents say they are very or somewhat interested in receiving this type of information.
This issue matters.
According to the US Centers for Disease Control and Prevention (CDC):
- Non-adherence causes ~30 to 50 percent of treatment failures and 125,000 deaths annually
- Non-adherence to statins increases relative risk for mortality (~12 percent to 25 percent)
- Non-adherence to cardio-protective medications increases risk of cardiovascular hospitalizations (10 to 40 percent) and mortality (50 to 80 percent)
- Poor adherence to heart failure medications increases the number of cardiovascular-related emergency department (ED) visits
Estimated US costs of non-adherence range from $105.8 billion for adults diagnosed with diabetes, hypertension, or dyslipidemia in 2010 to $290 billion for all patients in 2012.
Many purchasers of health care recognize the benefits of better adherence. Health systems and health plans are emphasizing better medication adherence through value-based care (VBC) and related quality initiatives. Many of the quality measures in the US Centers for Medicare and Medicaid Services (CMS) value-based purchasing programs are influenced by medication adherence, and some measures capture adherence directly. For example, control of hypertension and blood sugar – quality measures for accountable care organizations (ACOs) and Medicare Advantage plans – improves with higher levels of medication adherence. CMS also directly measures and rewards medication adherence for three conditions under Medicare health plans that cover both Part C and Part D benefits and standalone Part D plans.
So what should health systems and health plans do to succeed on these measures? And what can life sciences companies do to help?
One strategy to improve medication adherence may be to tailor it to a consumer’s economic, information, and incentive issues. For example, if a person’s reason for non-adherence is financial, one potential solution is providing access to a discount coupon or best-price drugs, information about generic options, or mail order savings. If the issue is side effects or skepticism about a medication’s benefits, scheduling a clinician consultation might be a good approach. Finally, if the issue is forgetfulness, the patient may benefit from a reminder app.
Other strategies around personalizing the approach to improving adherence might lie in lessons from behavioral economics. Non-traditional approaches, such as “nudging” patients toward adherence in a personalized way, may also help support adherence.
Personalized approaches will also need to recognize that adherence issues are often related to a patient not wanting to be reminded of their disease or condition, which certainly rings true in my case. The field of cognitive behavioral therapy might hold some potential for changing how one thinks about this issue and may hold some potential for breaking through strategies.
I think all of these ideas are worth more research. Perhaps if we take some of our best technologies and analytics to target solutions, we can see what works and eventually solve the adherence problem.